title: Serum ghrelin; a new surrogate marker of gastric mucosal alterations in upper gastrointestinal carcinogenesis.
abstract: BACKGROUND
  A few studies have indicated inverse relationships between serum ghrelin and gastric and esophageal cancers but those associations have been restricted to specific populations, including smokers and overweight individuals. We examined the association between ghrelin and gastroesophageal cancers and atrophic gastritis in a population-based setting.
  
  
  METHODS
  In total 220 gastroesophageal cancers, comprising non-cardia and cardia gastric cancer, esophageal adenocarcinoma, esophageal squamous cell carcinoma (SCC) and age and gender-matched controls were recruited. Serum ghrelin, pepsinogen I/II ratio (PGI/II) and anti-H.pylori IgG antibodies were measured. Relationships between ghrelin and gastroesophageal cancers, after adjustment for PGI/II ratio, H.pylori status and smoking, were tested using logistic regression. Furthermore, in 125 endoscopically normal volunteers, with and without histological atrophic gastritis, the relationship with ghrelin was compared.
  
  
  RESULTS
  Serum ghrelin (lowest vs. highest quintile) was inversely associated with gastric cancer: OR (95% CI) 8.71 (1.70-44.59) for cardia and 6.58 (1.26-34.46) for non-cardia cancer. Lower serum ghrelin was also associated with esophageal SCC: OR (95% CI) 5.69 (1.36-23.78), but not with esophageal adenocarcinoma. A similar association was observed between gastric cancer (cardia and non-cardia) and esophageal SCC when serum ghrelin was analysed as a continuous scaled variable. In endoscopically-normal volunteers, extensive atrophic gastritis was associated with low serum ghrelin [OR (95% CI) 0.25 (0.10-0.64)].
  
  
  CONCLUSIONS
  Inverse associations between ghrelin and some gastroesophageal cancers suggest a potential role for serum ghrelin as a biomarker of upper gastrointestinal cancers and atrophic gastritis. In areas with a high incidence of gastric and/or esophageal cancer, screening might be more effectively targeted to individuals with low serum ghrelin in addition to the PGI/II ratio.
authors.affiliation: Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran ; Department of Epidemiology, University of Groningen, University Medical Center Groningn, Groningen, The Netherlands.
authors.forename: Alireza
authors.initials: A
authors.lastname: Sadjadi
authors.forename: Abbas
authors.initials: A
authors.lastname: Yazdanbod
authors.forename: Yeong Yeh
authors.initials: YY
authors.lastname: Lee
authors.forename: Majid
authors.initials: M
authors.lastname: Boreiri
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Samadi
authors.forename: Behrooz Z
authors.initials: BZ
authors.lastname: Alizadeh
authors.forename: Farhad
authors.initials: F
authors.lastname: Islami
authors.forename: Valerie
authors.initials: V
authors.lastname: Fyfe
authors.forename: Masoud
authors.initials: M
authors.lastname: Babaei
authors.forename: Mohammad J
authors.initials: MJ
authors.lastname: Namazi
authors.forename: James J
authors.initials: JJ
authors.lastname: Going
authors.forename: Masoud
authors.initials: M
authors.lastname: Sotoudeh
authors.forename: Geertruida H
authors.initials: GH
authors.lastname: de Bock
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Derakhshan
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D004938:Esophageal Neoplasms / Q000097:blood*; D005753:Gastric Mucosa / Q000378:metabolism / Q000473:pathology*; D054439:Ghrelin / Q000097:blood*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016015:Logistic Models; D016017:Odds Ratio; D020116:Pepsinogen A / Q000097:blood; D020115:Pepsinogen C / Q000097:blood; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000097:blood*
chemical_list: D014408:Biomarkers, Tumor; D054439:Ghrelin; D007074:Immunoglobulin G; D020115:Pepsinogen C; D020116:Pepsinogen A